Postdischarge Pain Management After Thoracic Surgery: A Patient-Centered Approach

Area of Science:

• Pain Management
• Thoracic Surgery
• Pharmacology

Background:

• Effective postoperative analgesia is crucial for recovery after thoracic surgery.
• Current opioid prescribing practices are often standardized, leading to excess unused medication.
• Excess opioids increase the risk of nonmedical use and overdose.

Purpose of the Study:

• To investigate if patient and perioperative characteristics, specifically pre-discharge opioid consumption, can guide post-discharge opioid prescriptions.
• To develop a more personalized approach to opioid prescribing after thoracic surgery.

Main Methods:

• A prospective observational cohort study of 200 adult thoracic surgery patients.
• Patients were grouped by 24-hour pre-discharge opioid intake (none, low, high) in morphine milligram equivalents (MME).
• Logistic regression analyzed associations between characteristics and after-discharge opioid use.

Main Results:

• Preoperative opioid use, acetaminophen, gabapentinoid intake, and pre-discharge opioid intake were linked to higher after-discharge use.
• 24-hour pre-discharge opioid intake was the strongest predictor of after-discharge opioid use.
• Patients with no pre-discharge opioid use were 99% less likely to use high amounts post-discharge compared to those with high pre-discharge use.

Conclusions:

• Assessing 24-hour pre-discharge opioid intake can predict post-discharge needs.
• Targeted opioid prescriptions based on anticipated needs can improve prescribing practices after thoracic surgery.
• This personalized approach may reduce opioid-related risks.